A Case of A Baby with Bumpy Feet
Bilateral tiny lumps in a 4-month-old boy's heels are making his mother anxious. Get a close look at the lesions and enter your Dx.
A 4-month-old was born at 36 weeks; was kept for 2 weeks for treatment of minor respiratory issues then discharged with "clean bill of health.” At well child visit, mother notes hard bumps on the baby's heels.
The 4-month-old was treated for transient tachypnea of the newborn that resolved with no complications. The sole of one foot is seen with small calcified lesion.
Other than skin findings, the physical examination is normal.
Close-up view shows 1- 2-mm white papular lesion that is hard to the touch.
Heel of right foot shows similar 2-mm lump that feels like a subepidermal pebble. Similar lumps, the mother notes, have disappeared.
Based on the history and presenting information, what is your diagnosis?
Diagnosis:
Calcification secondary to heel sticks. Lesions appear 4-12 months after initial trauma, resolve after 18-20 months.
Lesions are asymptomatic; histology reveals acanthotic, hyperkeratotic epithelium overlying cystic dermal nodules with irregular calcification around the margins.
What would be included in your differential diagnosis?
Differential diagnosis of heel calcification: Calcinosis cutis: metastatic-increased Ca++/phosphate; dystrophic-previous damaged tissue - SQ fat necrosis; idiopathic; subepidermal nodules.
At a well child visit for her 4-month-old, a mother is concerned about bilateral tiny hard lumps under the skin of the baby's heels. She says there have been others that have "disappeared." Learn more about the baby's general health and PMH in this slide show and get a close look at the bumps. What's your diagnosis?
